Provider Demographics
NPI:1306572227
Name:SAM GONE, ADZOWO AKPEDZE FAFA
Entity type:Individual
Prefix:
First Name:ADZOWO AKPEDZE FAFA
Middle Name:
Last Name:SAM GONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 108TH ST APT 10C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3828
Mailing Address - Country:US
Mailing Address - Phone:646-525-9414
Mailing Address - Fax:
Practice Address - Street 1:900 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2523
Practice Address - Country:US
Practice Address - Phone:732-308-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001958176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty